The highly anticipated 2020 American Heart Association/American College of Cardiology Guidelines for the Diagnosis and Treatment of Patients with Hypertrophic Cardiomyopathy have been released.
This document, drafted with reference to published HCM literature, and with input from a committee of HCM experts with broad expertise, updates the prior version published in 2011. It contains clinical practice guidelines for the broad spectrum of issues which may confront medical professionals as they approach the diagnosis and treatment of patients and families affected by hypertrophic cardiomyopathy.
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The European Society of Cardiology recently published new guidelines for exercise for patients with HCM.
These guidelines offer more flexibility for HCM patients that past guidelines, stating that exercise may be permissible for HCM patients, but that it depends on individual situations. The focus should be on the shared decision process between patient and doctor to determine whether exercise may be appropriate for each individual patient. Additionally, annual follow up for adults, with more frequent follow up for adolescents and young adults is also recommended.
Section 5.5.1 of the guidelines focuses on Hypertrophic Cardiomyopathy. These guidelines state:
- The risk of sudden cardiac death or arrest (SCD or SCA) during exercise is likely lower than previously thought and therefore, a total ban on exercise is not warranted.
- Exercise for physical and psychological well-being should be encouraged, following a careful baseline assessment of patients with HCM which should include:
- Personal and family history
- Risk Factors for SCD/SCA
- EKG at rest and during exercise
- Echocardiogram/Degree of Obstruction
- Degree of late gadolinium enhancement indicative of cardiac fibrosis as seen on cardiac MRI
- Exercise testing and blood pressure response to exercise
- ESC Score of HCM Risk